Sammendrag
Introduction: Caesarean sections can be a lifesaving procedure that can prevent maternal and perinatal morbidity. While potentially lifesaving in certain circumstances, they can pose long and short-term health risks for mothers and their offspring when medically unnecessary. The global caesarean section rate has significantly risen since the 1990s and continues to rise, surpassing the recommended ideal rate for caesarean sections of 10-15% at population level put forward by the World Health Organisation. This indicates that a big proportion of caesarean sections are performed unnecessarily. Midwife led care has shown to offer a means to decrease unnecessary caesarean sections. This is due to the midwife philosophy they follow, focusing on normal birth that is in contrast to doctor led care, which is the standard form of maternity care in most countries. Aims and objectives: This study aims to investigate the potential of midwife led care in reducing unnecessary caesarean sections in low-risk women. The ‘potential’ of what midwife led care can offer to the reduction of caesarean sections is split into the three main aims of this study. Firstly, to identify the evidence for midwifery led in reducing unnecessary caesarean sections in low-risk women. Secondly, to identify how midwife led care has a different approach towards care of pregnant women and birth compared to doctor led care. And lastly, to discover the theoretical models or interventions used by midwifery led care that may be utilised for reducing caesarean sections. Methods: A scoping review was conducted on PubMed and Web of Science using a tailored search strategy for each database to identify literature on publications which reported on caesarean sections and midwifery led care, in order to catch all relevant literature. The Bramer method was used to de-deduplicate studies which were found through database searching. Subsequently, collected studies were screened based on pre-established inclusion and exclusion criteria. Key information was extracted from the remaining papers on a custom standardised data extraction and findings were summarised narratively to map the existing literature. Findings: Nineteen studies reported on caesarean section outcomes of low-risk women receiving either midwife led care or obstetrician led care, revealing mixed results. Further, there were six studies which reported on the experience of women receiving midwifery led care, revealing themes of maternal empowerment, fear and anxiety, satisfaction with pregnancy and childbirth and satisfaction with the environment under midwifery led care. Discussion on theoretical underpinnings were sparse in the literature. Lasty, interventions such as midwife led counselling and psycho education were shown to help reduce elective caesarean sections. Discussion/Conclusion: This study reveals that effective midwifery led care with its underlying midwifery philosophy of normal physiological birth may have significant contributions in increasing vaginal normal birth in low-risk women and thus reducing the rate of unnecessary caesarean sections. Furthermore, it demonstrates the importance of theory in informing practice.